DISCUSSION OF "DEATH" WITH AN INDIAN PATIENT
Hon. Visiting Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.
Everybody is not willing to die, but everybody is not afraid of 'death'. There are many Indians who are so afraid of death that mere thought or mention of it frightens them. We ail have to die one day. Extreme fear of 'death' makes "living" difficult.
In private practice one sees a number of patients whose symptoms are related to fear of death. As a student, I never saw such patients in the hospital wards.
Over the years I have learnt that the following are the methods to manage this situation.
1. A detailed examination of the organ or the system should be done. This in question may be blood pressure, heart or any other cavity (oral cavity for fear of cancer) or an organ (for example breast for cancer).
2. Special investigations may be done depending on the patient's suspicion - e.g. electrocardiogram for fear of heart (in this situation only resting ECG may be enough) or X-ray chest to exclude the suspicion of tuberculosis or a blood test for cholesterol etc.
3. A long, talk to convince the patient that everything is O.K.
4. Finally "desensitization" against the word "death". Since our country has not seen 'major' wars, people in India are very "scary".
The first thing I tell the patient is, "you are not going to "die" for the next 15 to 20 years (depending on the age)". By that I mean and I would like the patient to accept that one day he or she is going to "die" . It is interesting to see the reaction of the patient. Some patients who are already around sixty years old would get upset that they are going to live only 15 to 20 years! Then I would smile and add that you may live longer than that, but then I would not be around to see that!
There are still other patients of cardiac neurosis who would be wanting a stronger assurance that they will not die in that period. Then I would add that you certainly cannot die of heart for.... years, but I cannot promise that you will "not die" of an accident (the commonest cause of death in U.S.A.) or a war!!
All I am trying to achieve is to see that the patient should get immunised to the word "death". I feel that I have been successful when the patient says finally "Doctor that means I shall "die" only after years". He has probably used the word "I shall die" for the first time in his life!!!
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